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FOR OFFICE USE. '- -.APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) /•.� _ ,± ; Date Issued91-.144 -'" ' This Permit Expires 1 Year From Date Issued !1S Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein I described. This application is made[incompliance with County Ordinance No. 549 and existing Rules andl Regulations: t CENSUS TRACT ------------- - JOB ADDRESS/LOCATION --------------------_1---'.-1---- g �l - - Phone ��- � / -------- Owner's Name ------ -- ---- City -- Address -------- - --------------- �''" fjc License # Phone J 4A-7 Contractor's Name ------------ ------------- - - --- -- In`stollation will serve: ( Residence ❑Apartment House[] Commercial :❑Trailer Court l❑ u,,;' Motel ❑Other -------------------------------------------- --Garbage ____-- ___ - --------------------- - -- ---- j� J pp�� I .U--7_,X _V --------------- IVumber of living units�"t ,---- Number of bedrooms __Garbage Grinder -___________ Lot Size Water :56pply- Public ystem_ and name ---------------------------------------------------------------------------•--------------i---------- Private Peat Sand Loam • Clay Loom:[:] 1 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ ❑ y Hardpan ❑, Adobe Fill-Material __ ----__�If yes, type -- ------------------------- t. I (Plot plan, showing size of lot, location of system ,in relation to wells;buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic�tanlc.lo sr eepdge„pita`p rmitted if public �twer is`available within 200 feet,) i/ i ---- Li uid De th ------+.5_ - PACKAGE TREATMENT [ ] SEPTIiC TAMC;j ..��`� S' e------------� X'ter, tq p �`- --- ' Capacity,_� Type Material -'-- --- No. Compartments - i Foundation _-_ ---�-- -- -- Pro Line _______-- --...__ Distance'-to-nearest:-WellY-----J1^, --- --- r� I gip: , l LEACHING LINE [ ]', No. of Lines - ------ -- Length of each line ------ Tota I L�engtKq}t_- --- ____De th Filter Materiel: ____ = =r___•---------------- 'D' -- 'D' Box '---- -- Type Filter Material p e. t �� , r ., Distance to nearest: Well -_ � -- _ Foundation _-___1Q:_______- _-- Property Line. -----'5-----•- f r� Number - -------------- Rock Filled Yes No 0 t � SEEPAGE PIT [ ] Depth} Diameter _ ------ •-- f Water Table Depth -_ ------ ------ ck Size Distance to nearest: We 11 ---------/-�_0--------- -----Foundation , L ----- Prop. Line --------=------•- i ! - ----- ----- Date ---- -----------------------{-----} REPAIR/ADDITION(Peev. Sanitation Permit# ------IV 1------ S I I ------- Septic Tank (Specify Requirements) -------- ----- --------------------------- - Disposal Field (Specify Requirements) ___- - = ------ -- ----------------------•---•----,------ --- - --- --------�--- ------ --- --------------------------------------------- - (Draw existing and required addition on everse I hereby certify thatl_have prepared this application and-that the work will be done in accordance with San Joaquin E County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: ` "I certify that in the performance of the work for which this permit is issued, 4 shall not employ any person in such manner as to become subject-to-Workman"s..Compensation-laws of-California." [ Owner Signed ---------------------------------; -------------- -------------------------------------------- i ___ --------------------- Title -------------------- r--------------- BY - i -- `----- fi (if other t owner) I ! FOR DEPAitTMENT USE ONLY APPLICATION ACCEPTED BY ___ .__ DATE ___ _ D -` ti17 ----------------------------- BUILDING PERMIT ISSUED --------- ------� ---------------------------- -- ----------- DAT f ADDITIONAL COMMENTS ------------yo �. IC��_C� �t ! ' ---------------------- { ---- f---- --------- ----' - -------------j----------- ------ --- ------- --�. ---w' �-- -�.------ ----- ------ ------------------ Final Inspection by -' �� ------------------------------------------ � iA I -- - SAN`J . A'QUIN"LOCAt7HEALTH—DISTRICT` r ` E. H. 9 1-'68 Rev. 5M.